Present: President and General Manager, MAXIMUS Health Services Segment
Career history: Prior to joining MAXIMUS in 2004, Caswell was at IBM Corporation for nine years, in a variety of roles focused on federal, state, and local governments. Before then, he served as manager for Price Waterhouse, in its Office of Government Services' Policy Research and Analysis practice unit.
Personal: Caswell is a devoted marathoner. “I turned to running just after September 11, 2001 as a way to get more focused and disciplined in my life,“ says Caswell. He's since done 14 marathons and one ultra-marathon “” a 50-mile race, this past fall. “It certainly tests the body and the spirit when you're running that long,“ he says.
- Get in on the standards-setting conversation. “Many states have put together workgroups to help govern how they'll deal with the $19 billion [government healthcare IT investment] as it comes down,“ says Caswell. “Getting engaged in standards committees and workgroups is critical“¦that's a great forum in which to have your ideas heard. You end up potentially having a bigger impact on the outcome than just sitting around and waiting for the news to be reported.“
- Broaden your vision of potential health IT partners. “You're going to see companies form partnerships that customarily you might never have seen. For example, we recently looked at an opportunity to bid on the core backbone of a health information network; a requirement of the bid was that the prime contractor had to have done it before. It caused us to look at who we could partner with in order to meet the requirements and give us capabilities in a new area.“
ExecutiveBiz: Let's start with the $19 billion for healthcare IT that Congress set aside this past February. What contracting opportunities do you see continuing into 2010?
Bruce Caswell: First of all, we're thrilled that the efforts funded under the stimulus package are progressing in the form of the HIE grants to the states and the creation of the Regional Extension Centers. There's a real wave of opportunity being created for vendor communities to support states as they assist in the deployment of electronic medical records. We see a lot of opportunity in 2010 associated with states as they work through the procurement process to put the supporting contracts in place to meet the requirements of the stimulus bill in that area.
ExecutiveBiz: Turning to healthcare reform, what opportunities do you see there?
Bruce Caswell: Clearly, with large scale federal legislation losing momentum, we'll likely see incremental change in the areas of Medicaid reforms, coverage expansions to include children and childless adults, and companion provisions to address subsidies, incentives for small employers, and insurance reforms (such as pre-existing condition exclusions). Opportunities, in the near term, will be centered on core programs like Medicaid and CHIP, and are likely to include the long-term care population, which represents more than 35 percent of Medicaid spending. Certainly, the vast majority of states lack the money to meet the funding requirements envisioned in the original legislation, and many have implemented or are contemplating cuts in their benefit packages. However, if states see some likelihood of an increased federal Medicaid match continuing for another 18 months, they're more likely to maintain current benefits levels and may work to expand to selected new populations.
ExecutiveBiz: Patient engagement is something you speak a lot about. How can it be implemented for more effective healthcare reform?
Bruce Caswell: Adequate provisions need to be made for dealing with low literacy populations. People who actively participate in their healthcare choices have better health outcomes. People who aren't engaged in their own healthcare, who aren't proactive and don't understand their doctors, ultimately get worse care, are sick more often, and die prematurely. That has a huge economic impact on our country, as evidenced in a recent study published by the Center for Health Disparity Solutions at the Johns Hopkins Bloomberg School of Public Health. We think addressing that is ultimately traceable to improving health literacy or at least making provisions for it. To help address the issue, we have an organization, the MAXIMUS Center for Health Literacy, which develops communications that are culturally and linguistically sensitive to low literacy populations. For example, we build usability testing into the development phase of all our literacy projects, testing websites and print materials with people who represent the same demographics as the target audience. Our experience has taught us that in order to reach an audience we need to communicate in their language, at their literacy level, and use examples and illustrations that speak to their cultural experiences.
ExecutiveBiz: Turning to other markets. British Columbia, in many ways, leads other parts of North America in the e-health area. You're a part of that effort, as evidenced by a 10-year $268 million contract with the British Columbia Ministry of Health. What's the latest on this project?
Bruce Caswell: One of the major programs that we administer for British Columbia is PharmaNet. As the name would imply, that's the system by which pharmacy claims are processed for prescription drugs, which are dispensed at the point of service. The claims are ultimately settled and the pharmacies are paid for their claims. We're leading an effort to transform the entire PharmaNet program into what is called PharmaNet 2. An element of this includes the implementation of a new Drug Information System (DIS) that provides utilization review and can detect drug interactions prior to dispensing. This will effectively be the most sophisticated and functional e-prescribing DIS project in Canada when it is completed “” a very significant stride. The PharmaNet2 project will conform to the new Pan-Canadian messaging standard, HL7v3. As such, there are direct functional similarities between this effort and the developing ePrescribing/eDrug environment in the United States. MAXIMUS recently completed the acquisition of a Canadian firm, DeltaWare, who provides this leading DIS platform. We're optimistic that our efforts in Canada can be of benefit to our U.S. government customers as well.
ExecutiveBiz: The future of healthcare IT belongs to analytics. What's MAXIMUS doing in that area?
Bruce Caswell: Certainly, there's already a lot of great data out there in the form of Medicaid claims that can be used initially to populate electronic records or personal health records. We're working with our State Medicaid clients to design portals that can reach back into the Medicaid claims database and populate Medicaid personal health records so that you have basic information on a patient to use while these health information exchanges are being implemented and starting to gain traction. While this area is still “early days,“ as it's tied to the State HIE grant activities, we're finding that Medicaid administrators see the need for such a gateway to include their beneficiary population, and the supporting services (like consent management) that must accompany this.
ExecutiveBiz: What's your view of the current definition of “meaningful use“?
Bruce Caswell: It's a good general standard, but there's still a lot of ambiguity. Most of the discourse right now is centered on the definition of quality standards. But it doesn't specifically address hybrid situations; for example, a cardiology practice where the cardiologist provides some primary care. In that setting, it isn't clear what the responsibilities are of the cardiologist who provides that primary care. The good news is that the five areas broadly addressed in the current meaningful use standard do incorporate the concept of patient engagement and a focus on patient-centered rights. We're thrilled that that's at least reflected in the current standard. But it doesn't really get implemented until 2013. That isn't soon enough, in our view.
ExecutiveBiz: Where will MAXIMUS be contributing on the patient-centric side of healthcare IT next?
Bruce Caswell: While advancing the need for healthcare IT to be more patient-centric, our activities address the roles of patients, providers, and program administrators. Specifically, working with Intel and Initiate Systems, we are bringing a Medicaid Gateway offering to our state customers, comprising a software application and services that can enable the integration and participation of the Medicaid population in the new State Health Information Exchanges. Additionally, I previously mentioned the Recipient Portal that we've developed with particular emphasis on low literacy populations. This effort benefits not only the patient, but can enable providers to comply with Meaningful Use criteria for Federal incentive payments. Finally, a cornerstone of any patient-centric approach is privacy. We have authored white papers and are developing solutions to address Consent Management. This is a complicated area, as there are laws and regulations that supersede HIPAA and HISPC rules for eHealth data. It is, however, essential to creating the environment of trust that is ultimately essential to adoption. As you can see, our view is that a patient-centric perspective is critical to the success of healthcare IT.